Customer Solutions And Performance Analyst Resume Example

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(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
Professional Summary
Incredibly personable Solutions and Performance Analyst with over ten years of experience in claims, escalations, billing & appeals. Accurate and detailed oriented with knowledge of HIPAA Guidelines, CPT and ICD-9 coding and medical terminology.
  • Ability to acclimate to change quickly
  • Motivator who meets high performance standards
  • Greatdecision making skills
  • Billing, Claims, Group and individual benefits

  • Data Analyst and Trend reporting
  • Medicare and HIPAA guidelines knowledgeable
  • Medical terminology expert
  • Composed and professional demeanor
  • Excellent problem solver
Winston-Salem State University Winston Salem, NC Expected in 2010 Bachelor of Arts : Psychology - GPA : Psychology
Work History
Flightsafety International Inc. - Customer Solutions and Performance Analyst
San Antonio, TX, 08/2016 - Current
  • Precisely resolve all provider and member Billing/claim issues and escalations as a floor supervisor.
  • Conduct skill gap analysis in collaboration with leaders to identify specific skill needs and goals leading to an increase in customer satisfaction.
  • Support benefits, eligibility & claims training classes and projects as subject matter experts, including class prep, scenario validation, learner observations, feedback & floor support.
  • Design, develop and implement learning action plans to increase knowledge and workplace productivity by 70%
  • Adeptly managed call center forecast using Avaya CMS Supervisor management tool.
  • Thoroughly research quality and compliance issues/trends while making recommendations for improvement.
Blue Cross Blue Shield Of NC - Subject Matter Expert
City, STATE, 10/2015 - 07/2016
  • Assist Facilitators in the role progression/new hire classrooms for benefits, claims and billing lines of business to guarantee customer satisfaction.
  • Actively performed QA monitoring using real time or recorded calls and provided honest feedback to team leads using an observation template
  • Precisely provided updates on escalations and billing/enrollment exception requests & provider claims escalation.
  • Confidently traveled to BCBSNC different sites (Winston Salem, Charlotte, Durham, Fayetteville, Greenville Jacksonville) to assist facilitators with new hire/role progression classes for claims, benefits, eligibility & billing for member and provider stakeholder.
  • Act as the first level of escalation for customer service professionals during on the job training for member and provider stakeholder.

Blue Cross Blue Shield Of NC - Inter-Plan Program Host Customer Service Rep Provider Stakeholder
City, STATE, 03/2014 - 09/2015
  • Confidently and adeptly handled claim denials and/or appeals for out of state policies while resolving claims and payment issues.
  • Actively assisted providers with navigating through Blue E provider portal. Resourcefully Inter-Plan Teleprocessing Services (ITS) to communicate with/research responses from other Independent Blue Cross Association plans.
  • Accurately transferred knowledge to Inter-Plan Program Host front line while supporting the help desk.
  • Diligently take the place as first level of escalation while assisting on the knowledge transfer Help desk.
  • I nteracted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
2016 Spot award RecipientThe Spot Award program allows managers to reward performance excellence for exceptional demonstration of The Way Forward and BCBSNC\'s cultural attributes - collaboration, caring, commitment and creativity. Employees who receive a Spot Award practice model behavior and exercise enterprise thinking in alignment with BCBSNC strategic direction. This award is most appropriate when the employee\'s contribution is measurable in financial terms, or it has significant impacts on the enterprise as it relates to our corporate strategies.
Additional Information

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Resume Strength

  • Length
  • Personalization
  • Strong Summary
  • Target Job

Resume Overview

School Attended
  • Winston-Salem State University
Job Titles Held:
  • Customer Solutions and Performance Analyst
  • Subject Matter Expert
  • Inter-Plan Program Host Customer Service Rep Provider Stakeholder
  • Bachelor of Arts

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